Bulacan State University
City of Malolos, Bulacan
College of Nursing
Case Study of Patient with Acute
Gastroenteritis
Submitted by:
Calma, Therese Josephine
Censon, Luwalhati
BSN – 3D
Submitted to:
Maribel Valencia, R.N.
I. INTRODUCTION
Acute Gastroenteritis
Acute Gastroenteritis is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine and resulting in
acute diarrhea. The inflammation is caused most often by infection with certain viruses, less often by bacteria or their toxins, parasites, or
adverse reaction to something in the diet or medication. At least 50% of cases of gastroenteritis as foodborne illness are due to norovirus.
Another 20% of cases, and the majority of severe cases in children, are due to rotavirus. Other significant viral agents include adenovirus and
astrovirus.
Different species of bacteria can cause gastroenteritis, including Salmonella, Shigella, Staphylococcus, Campylobacter jejuni,
Clostridium, Escherichia coli, Yersinia, and others. Each organism causes slightly different symptoms but all result in diarrhea. Colitis,
inflammation of the large intestine, may also be present. Some types of acute gastroenteritis will not resolve without antibiotic treatment,
especially when bacteria or exposure to parasites are the cause. Physicians may want to diagnose the cause by analyzing a stool sample,
when stomach symptoms remain problematic.
Worldwide, inadequate treatment of gastroenteritis kills 5 to 8 million people per year and is a leading cause of death among infants
and children under 5. The most common symptoms are diarrhea, vomiting and stomach pain, because whatever causes the condition inflames
the gastrointestinal tract. Another reason to seek medical treatment is that some forms of acute gastroenteritis mimic appendicitis, which may
require emergency treatment. As well, young children run an especially high risk of becoming dehydrated during a long course of the stomach
flu. One should receive directions regarding how to help affected kids or adults get more fluids. Sometimes children, those with compromised
immune systems, and the elderly may require hospitalization and intravenous fluids. Dehydration can actually cause greater nausea, and can
begin to cause organ shut down if not properly addressed.
Acute gastroenteritis is quite common among children, though it is certainly possible for adults to suffer from it as well. While most
cases of gastroenteritis last a few days, acute gastroenteritis can last for weeks and months.
Acute gastroenteritis remains a serious health issue, and is responsible for over 50,000 hospitalizations of children. In developing
countries, acute gastroenteritis is the leading cause of death for infants. Acute gastroenteritis should thus be taken seriously, and people
should not hesitate to seek medical treatment for especially seniors and children who have been ill for more than a day.
In the Philippine Health Statistic, gastroenteritis range as number 10 in the ten leading causes of infant mortality, with the rate of 0.5
and percentage of 4.1 cases in the Philippines by the year 2004 this was updated last February 12, 2008.
Significance of the study:
his study will enable the students to understand better about acute gastroenteritis and will explain the different risk factors for
developing the disease, including consumption of improperly prepared foods or contaminated water and travel or residence in areas of poor
sanitation Since we are client-centered, we really should consider our patient’s comfort and this study will give the students sufficient
knowledge that will help them to plan and implement nursing care plans that will satisfy patient’s needs.
II. OBJECTIVES:
A. General Objectives
This study aims to convey familiarity and to provide an effective nursing care to a patient diagnosed with Acute Gastroenteritis through
understanding the patient history, disease process and management.
B. Specific Objectives
1. To present a thorough assessment, through Nursing Health History, Gordon’s Typology 11 Functional Pattern, Physical Assessment, and
the interpretation of the laboratory examination done on the patient.
2. To discuss the anatomy and physiology, pathophysiology of the patient’s condition, usual clinical manifestations and possible
complications of this condition.
3. To have knowledge to the client medication and be familiar to that medication.
4. To formulate a workable nursing care plan on the subjective and objective cues gathered through nurse-patient interaction to be able to
help the patient recover.
III. PATIENT'S PROFILE
A. Biographical Data
Date: July 16, 2009 Clinical Area : Pedia ward room 202
Name : Ms. BB
Address : San Isidro II, Paombong, Bulacan
Date of Birth : November 5, 2005
Age : 3 ½ years old
Sex : Female
Civil Status : Single
Nationality : Filipino
Religious Preferences : Born Again Christian
Health care financing : Philhealth and Financial health assistance from baranggay health center
Date of Admission : July 15, 2009
Diagnosis : Acute Gastroenteritis with signs of dehydration
B. Chief Complaint
According to the significant others, the client was vomiting and defecating that’s why they rushed her to the hospital.
IV. HEALTH HISTORY
A. History of Present Illness
Prior to admission, the client was vomiting and defecating. Her stool was watery and its color is green. At first, they to the baranggay
health center and the midwife gave them medication. According to the midwife, the medication is for LBM, but after drinking the medication,
the client was still defecating and vomiting so the family decided to rush the client at Emilio G. Perez Memorial District Hospital the next day.
B. Past History
The client had fever, cough and colds. She had completed all vaccinations including BCG, DPT, Oral Polio Vaccine, MMR and
Hepatitis B vaccine. The patient had never been any of the childhood disease such as measles, mumps and chicken pox. The patient had no
history of accident or any injury. She does not have allergy in any food or drug. She was not hospitalized before and she does not take any
medication or supplements to maintain her health.
C. Family History
According to the significant others of BB they have a familial disease of asthma, both on her father and mother's side. And an incident
of hypertension on his father's side.
Genogram:
Legends
EC
55 y/o
HPN
LB
54 y/o
VB
33 y/o
LP
32 y/o
ASTH
KM
31 y/oMB
29 y/o
LO
35 y/o
ASTH
PC
31 y/o
JB
28 y/o
HE
23 y/o
ASTH
EB 56y/o HPN
RC
57 y/o
HPN
Paternal Maternal
CB
1 y/o
BB
3 ½ y/o
JC
20y/o
AC
22 y/o
ACTIVITIES OF DAILY LIVING
Functional Health Perception Prior to Hospitalization During Hospitalization
Nutritional Metabolic Pattern
Ø The client eats four times a day
including breakfast, lunch, merienda and
dinner. According to the significant
others, she always eats rice and soup.
She can drink 4 glasses of water in a
day. She has no eating discomforts. She
does not have any dental problems
because she has a complete set of teeth.
3 days food recall
July 11
3 cups rice
3 cups soup
4 glasses of
water
July 12
3 cups rice
1 piece of
egg
½ piece
paksiw na
bangus
3 glasses of
July 13
3 cups rice
3 cups soup
2 pices of
bread
4 glasses of
water
> The client seldom eats at the hospital. She
does not have appetite for eating. She seldom
drinks water or other fluids.
3 days food recall
July 14
2 cups rice
1 bowl of
sinigang
soup
2 glasses of
water
July 15
1 glass of
water
July 16
2 pieces
ponkan
½ glass of
water
Elimination Pattern
Activity-exercise Pattern
Sleep-rest Pattern
water
Ø The client defecates everyday and her stool is soft but formed and its color is brown and has a foul odor. She urinates five times a day and is yellowish in color. She has no discomfort in defecating and urinating.
Ø The client has sufficient energy for
completing her desired required
activities.
0- feeding
0- clothing
II- bathing
II- grooming
Ø The client sleeps about 10 hours a
day. From 8pm to 6am. She has no
problem falling asleep and does not take
sleep medications. Her sleep is always
Ø The client defecates three times a
day. Her stool is watery and its color is
green. She urinates twice a day and it is
yellowish in color.
Ø The client does not have sufficient
energy for completing her desired
required activities.
II- feeding
II- clothing
II- bathing
II- grooming
Ø The client still sleeps 10 hours a day.
She only wakes up when her
medications are due. She has no problem
falling asleep and does not take any
Cognitive-Perceptual Pattern
Role-relationship Pattern
Value-belief Pattern
continuous especially when she is tired.
She takes a nap during afternoon. From
12:30pm to 3pm.
Ø The client does not have difficulty in
hearing and has no hearing aid.
According to the significant others,
whenever the client feels pain or any
discomfort, they always give her
medications.
Ø The client lives with her mother,
father and grandparents. The structure of
her family is extended. And just like the
typical family, their family has problems
wherein they have difficulty in handling,
as stated by the grandmother.
Ø The client is a born again Christian.
According to the significant others, they
attend mass every Sunday.
sleep medications. She does not take
naps.
Ø The client takes medications to
relieve any discomforts.
Ø The Family of the patient especially
her parents are supportive and more
caring.
V. DEVELOPMENTAL TASK
Erik Erikson-Psychosocial development
The patient is currently in the early childhood stage (3-6 y/o) wherein the central task is Initiative vs. Guilt. During this stage, initiative
adds to autonomy the quality of undertaking, planning, and attacking a task for the sake of being active and on the move. The child is learning
to master the world around him or her, learning basic skills and principles of physics; things fall to the ground, not up; round things roll, how to
zip and tie, count and speak with ease. Guilt is a new emotion and is confusing to the child; he or she may feel guilty over things which are not
logically guilt producing, and he or she will feel guilt when his or her initiative does not produce the desired results. At this stage the client
wants to begin and complete her own actions for a purpose.
Interpretation: Positive Resolution
Jean Piaget’s Cognitive Development
The patient is under the Pre-operational stage. In this period intelligence is demonstrated through the use of symbols, language use
matures, and memory and imagination are developed, but thinking is done in a nonlogical, nonreversible manner. Egocentric thinking
predominates. The patient was able to do make believe play and able to imitate others, like her mother doing some household chores as
verbalized by the "SO".
Interpretation: Positive Resolution
VI. PHYSICAL ASSESSMENT
Date: July 16, 2009 Clinical Area : Pedia ward room 202
BODY PARTS
ASSESSEDTECHNIQUES NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION
1.Skin
a. Moisture Palpation Moisture in skin folds and axillae Dry skin Deviated due to slight
dehydration
b Texture Palpation Smooth Rough Deviated due to slight
dehydration
c. Turgor Inspection and
Palpation
Springs back immediately to
previous state
Moves back slowly Deviated due to slight
dehydration
2. Mouth
a. LipsInspection Pink in color, soft moist, smooth
texture, symmetrical no
tenderness, no lesions
Dry lipsDeviated due to slight
dehydration
b.Mucosa Inspection and
Palpation
Uniform pink color Dry and slightly pink in color Deviated from normal due
to slight dehydration
c. Gums Inspection and Pink gums, moist, firm texture Pink gums, dry, firm texture Deviated from normal due
Palpation to slight dehydration
3. Abdomen
Bowel sounds Auscultation Audible bowel sounds Hyperactive bowel sound Deviated due to diarrhea
VII. REVIEW IF SYSTEM
Digestive System
The primary function of the digestive system is to break down the food we eat into smaller parts so the body can use them to build and
nourish cells and provide energy. There occurs propulsion which is the movement of food along the digestive tract. The major means of
propulsion is peristalsis, a series of alternating contractions and relaxations of smooth muscle that lines the walls of the digestive organs and
that forces food to move forward. It secretes digestive enzymes and other substances liquefies, adjusts the pH of, and chemically breaks down
the food. Mechanical digestion is the process of physically breaking down food into smaller pieces. This process begins with the chewing of
food and continues with the muscular churning of the stomach. Additional churning occurs in the small intestine through muscular constriction
of the intestinal wall. This process, called segmentation, is similar to peristalsis, except that the rhythmic timing of the muscle constrictions
forces the food backward and forward rather than forward only. Chemical digestion which is the process of chemically breaking down food into
simpler molecules. The process is carried out by enzymes in the stomach and small intestines. Then absorption or the movement of molecules
(by passive diffusion or active transport) from the digestive tract to adjacent blood and lymphatic vessels. Absorption is the entrance of the
digested food into the body. And lastly, defecation which is the process of eliminating undigested material through the anus.
But because of acute gastroenteritis the normal functions were altered. The infectious agents that cause acute gastroenteritis causes
diarrhea by adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production.
These mechanisms result in increased fluid secretion and/or decreased absorption leading to diarrhea. This produces an increased luminal
fluid content that cannot be adequately reabsorbed, leading to dehydration and the loss of electrolytes and nutrients.
VIII. ANATOMY AND PHYSIOLOGY
The human digestive system is a complex series of organs and glands that processes food. In order to use the food we eat, our body
has to break the food down into smaller molecules that it can process; it also has to excrete waste.
Most of the digestive organs (like the stomach and intestines) are tube-like and contain the food as it makes its way through the body.
The digestive system is essentially a long, twisting tube that runs from the mouth to the anus, plus a few other organs (like the liver and
pancreas) that produce or store digestive chemicals.
The Digestive Process:
The start of the process - the mouth: The digestive process begins in the mouth. Food is partly broken down by the process of chewing and
by the chemical action of salivary enzymes (these enzymes are produced by the salivary glands and break down starches into smaller
molecules).
On the way to the stomach: the esophagus - After being chewed and swallowed, the food enters the esophagus. The esophagus is a long
tube that runs from the mouth to the stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to force food from the throat
into the stomach. This muscle movement gives us the ability to eat or drink even when we're upside-down.
In the stomach - The stomach is a large, sack-like organ that churns the food and bathes it in a very strong acid (gastric acid). Food in the
stomach that is partly digested and mixed with stomach acids is called chyme.
In the small intestine - After being in the stomach, food enters the duodenum, the first part of the small intestine. It then enters the jejunum
and then the ileum (the final part of the small intestine). In the small intestine, bile (produced in the liver and stored in the gall bladder),
pancreatic enzymes, and other digestive enzymes produced by the inner wall of the small intestine help in the breakdown of food.
In the large intestine - After passing through the small intestine, food passes into the large intestine. In the large intestine, some of the water
and electrolytes (chemicals like sodium) are removed from the food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus,
Escherichia coli, and Klebsiella) in the large intestine help in the digestion process. The first part of the large intestine is called the cecum (the
appendix is connected to the cecum). Food then travels upward in the ascending colon. The food travels across the abdomen in the
transverse colon, goes back down the other side of the body in the descending colon, and then through the sigmoid colon.
The end of the process - Solid waste is then stored in the rectum until it is excreted via the anus.
Digestive System Glossary:
anus - the opening at the end of the digestive system from which feces (waste) exits the body.
appendix - a small sac located on the cecum.
ascending colon - the part of the large intestine that run upwards; it is located after the cecum.
bile - a digestive chemical that is produced in the liver, stored in the gall bladder, and secreted into the small intestine.
cecum - the first part of the large intestine; the appendix is connected to the cecum.
chyme - food in the stomach that is partly digested and mixed with stomach acids. Chyme goes on to the small intestine for further digestion.
descending colon - the part of the large intestine that run downwards after the transverse colon and before the sigmoid colon.
duodenum - the first part of the small intestine; it is C-shaped and runs from the stomach to the jejunum.
epiglottis - the flap at the back of the tongue that keeps chewed food from going down the windpipe to the lungs. When you swallow, the
epiglottis automatically closes. When you breathe, the epiglottis opens so that air can go in and out of the windpipe.
esophagus - the long tube between the mouth and the stomach. It uses rhythmic muscle movements (called peristalsis) to force food from the
throat into the stomach.
gall bladder - a small, sac-like organ located by the duodenum. It stores and releases bile (a digestive chemical which is produced in the liver)
into the small intestine.
ileum - the last part of the small intestine before the large intestine begins.
jejunum - the long, coiled mid-section of the small intestine; it is between the duodenum and the ileum.
liver - a large organ located above and in front of the stomach. It filters toxins from the blood, and makes bile (which breaks down fats) and
some blood proteins.
mouth - the first part of the digestive system, where food enters the body. Chewing and salivary enzymes in the mouth are the beginning of
the digestive process (breaking down the food).
pancreas - an enzyme-producing gland located below the stomach and above the intestines. Enzymes from the pancreas help in the
digestion of carbohydrates, fats and proteins in the small intestine.
peristalsis - rhythmic muscle movements that force food in the esophagus from the throat into the stomach. Peristalsis is involuntary - you
cannot control it. It is also what allows you to eat and drink while upside-down.
rectum - the lower part of the large intestine, where feces are stored before they are excreted.
salivary glands - glands located in the mouth that produce saliva. Saliva contains enzymes that break down carbohydrates (starch) into
smaller molecules.
sigmoid colon - the part of the large intestine between the descending colon and the rectum.
stomach - a sack-like, muscular organ that is attached to the esophagus. Both chemical and mechanical digestion takes place in the stomach.
When food enters the stomach, it is churned in a bath of acids and enzymes.
transverse colon - the part of the large intestine that runs horizontally across the abdomen.
IX. PATHOPHYSIOLOGY
Etiology: Salmonella, Shigella, Staphylococcus, Campylobacter jejuni,
Clostridium, Escherichia coli, Yersinia,Norovirus, adenovirus
Person to person (hands) Contaminated food and/or water
Ingestion of Pathogens
Stimulation and destruction of mucosal lining of the bowel wall
Non-modifiable Factor: AgeModifiable Factors: Lifestyle; Diet; Hygiene
Direct invasion of the bowel wall Endotoxins are released
Digestive and absorptive malfunction Excessive gas formation GI Distention
Nausea & vomiting
Secretion of fluid & electrolytes in the intestinal lumen
Increased peristaltic movement
Increased secretion of Cl & HCO3 ions in the
bowel
Inhibition of Na reabsorption
Diarrhea
Fluid and electrolytes imbalance
Dehydration
Dry lips, dry mouth, flushed skin, fatigue,
irritability
X. LABORATORY FINDINGS
Complete Blood Count:
Blood Test Standard Range Actual Findings Interpretation
WBC 5.10 x 109/L 22.3 x 109/L The body is fighting against an infection
RBC 3.80-5.80 1012/L 5.53 x 1012/L Normal
HGB 110-165 g/L 136 g/L Normal
HCT .350-.500 1/l 0.441 1/l Normal
PLT 150-390x 109/liter 156 x 109/liter Normal
PCT.100-.500 10-2/l
.133 10-2/l Normal
MCV80 – 97 fL
80 fL Normal
MCH26.5 - 33.5 L
24.6 L An indication of microcytic, hypochromic anemia
MCHC315-350 Lg/l
308 Lg/l An indication of iron deficiency anemia
RDW10.0-15.0 %
15.1% An indication of iron deficiency anemia
MPV6.5-11.0 fL
8.5 fL Normal
% LYM17-48 L %
15.7 L% Normal
%MON4-10 L%
8.3 L % Normal
% GRA43-76 H%
81.0 H% Indicates presence of infection
# LYM1.2-3.2 109/L
3.5 109/L Indicates presence of infection
#MON0.3-0.8 109/L
0.7 109/L Normal
#GRA1.2-6.8 109/L
18.1 109/L Indicates presence of infection
Blood type: O
RH : +
Fecalysis:
Microscopic Findings Normal Values Actual Findings Analysis/Interpretation
Ova/ parasite NOPS Entamoeba Invasion of microorganismRBC 0-5/hpf 3-5/hpf Normal
Mucus 0- + Invasion microorganismsBacteria Negative(-) ++++ Invasion microorganisms
Pus Cells 0 8-12/hpf Invasion of microorganisms
XI. DRUG STUDY
DRUG NAME DOSAGE, ROUTE,
FREQUENCYINDICATION / ACTION CONTRAINDICATIONS ADVERSE EFFECTS
NURSING
RESPONSIBILITIES
1. Cefuroxime 250 mg
TIV
(q 8 hrs.)
- It interferes with the
final step in the
formation of the bacterial
cell wall.
- Lower respiratory
tract infection
- Hypersensitivity
to cephalosphorins
N and V, anorexia,
abdominal cramps or
pain and headache.
- Protect drug
from sunlight
- Instruct the
client to take with
food to enhance
absorption
2. Ranitidine 12mg
TIV
(q 6 hrs.)
- Inhibits gastric acid
secretion by blocking the
effect of histamine on
histamine H2 receptors.
- GERD
- Cirrhosis of the
liver
- Impaired renal or
hepatic function
Abdominal pain,
headache, dizziness,
malaise, N and V
- Take as
directed with
immediately
following meals
- Store at room
temperature
3.
Metronidazole
125mg/ 3.5 ml
PO
(q 8 hrs.)
- Inhibits growth of
amoebae by binding to
DNA, resulting in loss of
helical structure, strand
breakage, inhibition of
- Active organic
disease of the CNS
- Blood dyscrasias
- nausea, dry mouth,
vomiting, diarrhea
- Take with food
or milk to reduce
GI upset
- Drug may turn
urine brown, don’t
nucleic acid synthesis
and cell death.
- Amoebiasis
be alarmed.
XII. NURSING CARE PLAN
ASSESSMENT DIAGNOSIS BACKGROUND
STUDY
PLANNING INTERVENTION RATIONALE EVALUATION
Subjective:
Objective:
>Hyperactive
bowel sounds
>vomiting
>BM (4x),
watery and
greenish in
color
Diarrhea
related to
physiological
factors
(parasites)
Introduction of bacteria into the GI
tract
Release of bacterial toxins
Disrupts the mucus lining of the
stomach
Release of HCl cause gastric
irritation
Increase gastric motility/peristalsis
Increase gastric
After 8 hours of
Nursing Intervention,
client will be able to
reestablish and
maintain normal
pattern of bowel
functioning.
Independent:
>Monitor I/O.
>Restrict solid food
intake.
> Increase oral
fluid intake and
return to normal
diet as tolerated.
Dependent:
> Administer
antidiarrheal
medications as
indicated.
>These assessments
are used to monitor
volume status.
>To allow for bowel
rest/ reduced
intestinal workload
> To ensure
adequate amt. of
fluid is taken by the
pt.
> To decrease
gastrointestinal
motility and minimize
fluid loses
Goal met
After 8 hours of
Nursing Intervention,
client will be able to
reestablish and
maintain normal
pattern of bowel
functioning.
motility
Frequent defecation
(DIARRHEA)
ASSESSMENT DIAGNOSIS BACKGROUND
STUDY
PLANNING INTERVENTION RATIONALE EXPECTED
OUTCOME
Subjective:
Objective:
>watery stool
>vomiting
Risk for
deficient fluid
volume r/t
excessive
loss of fluids
and
electrolytes.
Digestive and
absorptive
malfunction
Increased secretion
of fluid and
electrolytes in the
lumen
Increased water
content of the stools
acompanied by
vomiting
Imbalanced fluid and
electrolytes
Risk for deficient fluid
volume
Reference:
After 2 hrs of nursing
intervention the ct with
the help of the "SO"
will be able to
demonstrate behaviors
to prevent
development of fluid
volume deficit.
Independent
>Monitor I/O
balance, being
aware of altered
intake or output.
>Offer fluids
between meals &
regularly
throughout the day.
> Promote intake of
high-water content
foods and/or
electrolyte
replacement drinks.
Dependent:
>Provide
supplemental fluids
as indicated.
>To ensure accurate
picture of fluid status.
>To prevent
occurrence of deficit
>To facilitate
hydration
> Fluids may be
given if the ct. is
unable to take oral
fluid, or when rapid
fluid resuscitation is
required.
Goal Meet
After 2 hrs of nursing
intervention the ct
with the help of the
"SO" was able to
demonstrate
behaviors to prevent
development of fluid
volume deficit.
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